How to manage aspergillosis in non-neutropenic intensive care unit patients

Abstract

Invasive aspergillosis has been mainly reported among immunocompromised patients during prolonged periods of neutropenia. Recently, however, non-neutropenic patients in the ICU population have shown an increasing risk profile for aspergillosis. Associations with chronic obstructive pulmonary disease and corticosteroid therapy have been frequently documented in this cohort. Difficulties in achieving a timely diagnosis of aspergillosis in non-neutropenic patients is related to the non-specificity of symptoms and to lower yields with microbiological tests compared to neutropenic patients. Since high mortality rates are typical of invasive aspergillosis in critically ill patients, a high level of suspicion and prompt initiation of adequate antifungal treatment are mandatory. Epidemiology, risk factors, diagnostic algorithms, and different approaches in antifungal therapy for invasive aspergillosis in non-neutropenic patients are reviewed.

Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: underlying conditions, diagnosis, and outcomes

“…Radiological findings are usually nonspecific in patients with aspergillosis. The typical halo and air crescent signs on CT images of the lungs are associated with low sensitivity for invasive fungal infection and are rarely observed in non-neutropenic patients [12, 21]. In the current study, the air crescent sign was detected on the CT scan of only one patient.…”

“…Diagnosing IFT is considerably difficult because of the nonspecific clinical manifestations and the lack of a diagnostic tool to distinguish colonization from infection [2, 12, 32, 33]. Radiological findings are usually nonspecific in patients with aspergillosis.…”

“…Diagnosing IFT is considerably difficult because of the nonspecific clinical manifestations and the low yields in microbiological tests [2, 11, 12]. The mortality rate of IFT caused by different fungi varies from 20 to 80% [11, 13–16].…”

Invasive pulmonary aspergillosis and influenza co-infection in immunocompetent hosts: case reports and review of the literature

“…A review of aspergillosis in non-neutropenic ICU patients concludes that mortality rates in this group may be higher than in immunocompromised patients with IPA (Bassetti et al, 2014). Of 11 immunocompetent patients with invasive aspergillosis and Influenza in a recent case series, 6 (55%) died (van de Veerdonk et al, 2017).…”

Plasmalyte: No Longer a Culprit in Causing False-Positive Galactomannan Test Results

“…Currently, positive serum testing on the GM enzyme immunoassay (Platelia Aspergillus; Bio-Rad, Marnes-La-Coquette, France) is one of the criteria for establishing the diagnosis of probable invasive aspergillosis in immunocompromised patients according to the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) (1). For the last decade, GM testing has also been applied on bronchoalveolar lavage (BAL) fluid, especially in nonneutropenic ICU patients, as this has been shown to have good sensitivity and specificity in diagnosing invasive aspergillosis in patients without the classic immunocompromising risk factors (2).…”